use of asthma control indicators in measuring efficacy of inhaled corticosteroids in asthmatic...
TRANSCRIPT
J ALLERGY CLIN IMMUNOL
VOLUME 133, NUMBER 2
Abstracts AB43
SATURDAY
154 Use Of Asthma Control Indicators In Measuring Efficacy OfInhaled Corticosteroids In Asthmatic Smokers: A SystematicReview
Ms. Claire E. Hayes, MPH, CHES, AE-C, Mr. Henry Nuss, PhD; Loui-
siana State University Health Sciences Center School of Public Health,
New Orleans, LA.
RATIONALE: Across studies investigators have reached competing
conclusions regarding the effectiveness of inhaled corticosteroids (ICS)
on improving asthma control in smokers. We completed a systematic
review of literature on the use of asthma control indicators to 1. Determine
how current research measures efficacy of ICS in asthmatic smokers as
well as to 2. Determine if current research supports claims that asthmatic
smokers are resistant to the effects of ICS.
METHODS: On-line databases PubMed, CINAHL, and PsycINFO were
searched using terms relating to asthma, tobacco use, and corticosteroid
effectiveness. Eligibility criteria included: Articles published between
2005 and 2013, English language, human subjects, adults (19 and older),
and studies using at least one indicator of control as a measure of ICS
effectiveness. The prevalence of asthma control indicators as well as
outcomes of individual studies were compiled and analyzed to determine
efficacy of ICS in patients.
RESULTS: Twelve studies met search criteria. Seven of these used only 1
indicator tomeasure asthma control in smokers.Additionally, ICSwas found
to be effective for smokers in only 4 of these studies. ICS was found to be
effective in all studies which used at least 5 indicators to measure control.
CONCLUSIONS: Inhaled corticosteroids are shown to improve asthma in
smokers whenmultiple control indicators are used to measure effectiveness.
Future studies should 1. Evaluate the effectiveness of ICS using multiple
indicators of control, as well as 2. Monitor patient adherence to ICS in
studies when determining appropriate asthma therapies for smokers.
155 Evaluation Of a Medication Adherence Estimator SurveyCompared To Exhaled Nitric Oxide (FeNO) Levels andAsthma Control Test In Difficult-To-Treat/Severe PediatricAsthma Patients
Jigar Patel1, Vanessa Y. Cavero, MD2, Amy Perkins, MS2, Heather
Minto, MD2, Maripaz B. Morales, MD2; 1Department of Pediatrics,
Eastern Virginia Medical School, Norfolk, VA, 2Children’s Hospital of
The King’s Daughters, Norfolk, VA.
RATIONALE: Many difficult-to-treat/severe pediatric asthma patients
are non-adherent to inhaled corticosteroid (ICS) therapy, resulting in
increased hospitalizations and emergency department visits as well as
reduced lung function. There is a need to develop a practical clinical tool to
assess adherence.
METHODS: CHKD Allergy/Immunology Clinic recruited 45 partici-
pants for a prospective observational study. Inclusion criteria: 7-18 years
old, diagnosed asthma, prescribed high dose ICS (>_1000 mcg/day).
Participants and parents completed Asthma Control Test (ACT) and
Adherence Estimator (developed by Merck and validated in adult chronic
disease population to assess medication non-adherence risk). FeNO was
measured. Charts were reviewed for demographics and medications. Data
were analyzed to obtain descriptive statistics and Spearman rank correla-
tion coefficients (rho).
RESULTS: 53.3% (n524) of subjects had a high FeNO level (>_20ppb)
and 62.2% (n528) had poorly controlled asthma according to ACT;
however, only 8.9% (n54) were high risk for non-adherence. 55.6%
(n525)were also onXolair step-up therapy. Therewas no significant linear
relationship between FeNO and Adherence Score (rho5-0.01) or between
FeNO and ACT Score (rho5-0.12). These coefficients were neither
statistically significantly different from zero nor greater than -0.55 (all
P>0.05). There was a very weak, negative association between AdherenceScore and ACT Score; rho5-0.32 was statistically significantly different
from zero (P50.03) but was not significantly greater than -0.55 (P>0.05).
CONCLUSIONS: Future studies should focus on constructing a medica-
tion adherence questionnaire that can be validated in a larger pediatric
asthma population.
156 An Assessment Of Infection Rates and Health Resource UseAmong Primary Immunodeficiency Disorder (PIDD) PatientsPrior To Diagnosis
Dr. Chris Rabbat, PhD, Ms. Diane Ito, MA, Ms. Yan Xiong, MS,
Dr. Josephine Li-McLeod, PhD; Baxter Healthcare Corporation, Westlake
Village, CA.
RATIONALE: It is hypothesized that undiagnosed PIDD may burden
both the patient with repeated infections and the healthcare system with
significant service utilization. This analysis assessed infection rates and
healthcare utilization among patients in the years leading up to a PIDD
diagnosis.
METHODS: This retrospective analysis utilized the Truven Marketscan
Database, 2002-2012. Patients who had at least 1 inpatient or ER diagnosis
or at least 2 outpatient diagnoses of PIDD (279.xx) and at least one of the
following PIDD diagnoses: 279.04, 279.01, 279.05, or 279.06 and 5 years
of continuous health plan enrollment were identified. The first PIDD
diagnosis (279.xx) was identified as the index date and data preceding the
index date were examined. Incidence rates of pneumonia, sinusitis,
bronchitis, otitis, as well as hospitalizations, outpatient visits and
outpatient drug utilization were analyzed.
RESULTS: 1388 patients were undiagnosed with PIDD for at least 5
years, of these, 84 were undiagnosed for at least 10 years, suggesting that
many patients are undiagnosed for years. The average percent increase in
rates of pneumonia, sinusitis, bronchitis and otitis per year over the 10
years prior to diagnosis were 39%, 20.4%, 20.2%, 14.2%, respectively.
Hospitalizations, outpatient visits and outpatient drug utilization increased
on average 29.1%, 10.5% and 5.3% per year, respectively during the same
time frame. This considerable increase in infections and hospitalizations
suggests the condition may be increasing in severity over time prior to
diagnosis.
CONCLUSIONS: The results suggest a more timely diagnosis of PIDD
may substantially ease the burden for both patients and the healthcare
system.
157 A Comparison Of Costs Between Outpatient Hospital, Clinicand Home Settings For Intravenous Immunoglobulin (IVIG)Infusions
Dr. Xiaolan Ye, PhD, Ms. Diane Ito, MA, Ms. Yan Xiong, MS,
Dr. Josephine Li-McLeod, PhD; Baxter Healthcare Corporation, Westlake
Village, CA.
RATIONALE: Home-based infusion of IVIG therapymay be beneficial in
terms of reduced costs compared to the outpatient hospital (OH) or clinic
setting. This analysis assessed cost differences between infusions con-
ducted at home versus OH or clinic using data from a large, commercial
medical claims database.
METHODS: Patients who had at least 3 months of continuous IVIG
claims were identified using J codes from the Truven Marketscan
Database, years 2002 -2012. Those who switched their infusion site of
care from the OH or the clinic to the home setting and had 3 or more IVIG
claims in each site of care were identified. Costs of care were compared
between the home and OH or clinic setting. Monthly costs were calculated
for each site, and the ratio between monthly cost at home and monthly cost
in the OH or clinic was calculated for each patient. Signed rank test was
used to determine statistical significance between sites.
RESULTS: There were 83 and 79 patients who switched their IVIG
infusion sites between clinic and home or OH and home, respectively.
Switching from OH to home infusions resulted in significantly lower
median costs ($6,916 v $4,188). The median home-to-OH cost ratio was
0.61 (p<0.0001), indicating the costs of care for the home-based infusions
were significantly less than the OH setting. The differences in costs
between clinic and home were not significant.
CONCLUSIONS: In this study, switching patients on IVIG treatment
from the OH to the home setting resulted in significant cost savings.